| NPI | 1477852713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI MD173340) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60833895) |
| 208600000X Surgery (Licence: OR MD195936) | |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2020-10-20 |